Morat20 in reply to DensityDuck says:

Ah, I see. CICO has to work, obviously, ’cause thermodynamics.

The problem with CICO and PCOS is that, well, CICO becomes rather difficult for actual people.

Once PCOS has hit obvious symptoms (that is, when most people actually get diagnosed as opposed to a gyno muttering about cysts), you’ve got that testosterone/estrogen imbalance creating insulin resistance which worsens the imbalance, etc.

Insulin resistance, among other things, makes your body claim it’s starving to your brain (cravings for food, especially high energy stuff like fats and carbs) and simultaneously flood your blood with sugar (because cells aren’t getting it) which your body stores as fat.

Which leaves you low-energy AND hungry for high-calorie feeds. Because your body thinks it’s starving, and cells aren’t getting the energy they need easily. Not exactly prime for diet and exercise.

There’s a reason hormone treatment and glucaphage is a lot more successful at treating PCOS after it’s hit a certain point than ‘diet and exercise’. It breaks that cycle.

Now the person I know that lost 20% of her bodyweight — her diet probably DID change, just not consciously. I suspect she ate less, and what she ate was less focused at high-calorie foods. And I know more energy was being used by her cells, instead of floating around as unused sugar to be turned into fat.

But if you gave her a Weight Watcher’s book and a treadmill, she wouldn’t have seen a fraction of the results. She’d have just been hungry and tired. And even if she used it, she’d have found her body would prefer to put on fat instead of build muscle (which means she’s see VERY slow stamina gains from exercise) and she’d be even hungrier and more tired from doing it.

OTOH, once medical treatment stopped (she even stopped talking the BC pills because she was trying for a kid) and a decade had passed, she had regained less than half the weight. Which is a heck of a lot better than I’ve ever seen off anyone who stopped their diet or exercise plan, and light years better than anyone who did a fad diet.

She’s back on the Pill, I think, and back to her low point weight if not a bit lower.

So yeah, CICO has to work because thermodynamics. But the way humans work — this woman was 20% heavier, with the exact same lifestyle, with untreated PCOS than with treated PCOS.

Whether treating PCOS made her eat less or exercise more or just magic violations of thermodynamics, she’s not the only one. Treating both sides of the feedback cycle causes weight loss.

How much? Depends on how bad your PCOS is, I’d imagine. But if FIXING the underlying problem and not deliberately changing anything else causes a 10% or 20% loss in weight, how can you say that the underlying problem wasn’t the cause of the 10% or 20% of weight in question?Report

Morat20 in reply to DensityDuck says:

Of course it is. If you use more calories than you take in, you lose weight. If you take in more calories than you use, you gain weight.

If you take in roughly the same as you use, you stay even.

Losing or gaining weight is about manipulating either how many you take or how many you use.

PCOS is ugly in that it lowers your body’s general ability to use calories, which means that even if nothing else changes (diet, exercise levels), you’ll suddenly start gaining weight. It’s doubly ugly in that it’s a starvation response — your cells can’t get the energy they need (not because it’s not there, but because they’re being blocked from accessing it efficiently) so your body starts screaming for food because it thinks you’re starving.

I literally don’t see what you’re arguing about. I’ve never ONCE suggested that your weight is set by anything other than the calories in versus the calories out (or burned). I’ve merely stated the obvious — that PCOS lowers your base metabolic burn rate (because your cells shift to a lower energy mode because they don’t have enough food) while making you think you’re starving.

Exercise is highly ineffective, because your cells will use as little energy as possible (they still think they’re starving). Just to use made up numbers — say you’re on a 2500 calorie diet and not gaining or losing weight — therefore, you burn about 2500 calories in your basic day. (20% of that just keeping your brain going! But the other 80% is moving around, breathing, repairing cells, etc). Your PCOS progresses and your cells start using less energy and now you’re burning 2000 calories a day, without having changed diet or activity levels. You’ll gain a pound a month at that rate, and keep gaining it until the caloric cost of maintaining that fat hits 500 calories a day. (Actually worse than that, because it’s a feedback cycle so until you hit some minimum weight you’ll find your caloric use will continue to drop).

Now you could exercise — an hour on the treadmill a day will push you back up to 2500, which won’t remove much of the weight you gained but might keep it from progressing. Or diet. But again, you’re suddenly working like crazy to maintain your heavier weight. Not lose it. 500 calories a day is a lot.

You’d need to cut another 500 calories to lose a pound a month — or add another hour on a treadmill. You’d be working twice as hard for the same result as someone without PCOS. Or working just as hard as them to NOT gain further weight, as they lose it.

And of course, the whole time your body is screaming at you that you’re starving and to eat fats, carbs, anything with tons of energy.

Or, you know, you could treat the PCOS. In which case your base burn rate goes back up to 2500, you’ll lose some weight right away — and exercise and dieting will be easier and far more effective. Which is why medically treating PCOS has a heck of a better record than demanding weight loss and exercise. The latter only works if you catch it very early, before you’re too deep in the feedback cycle or for people whose PCOS is not severe enough to trigger the feedback. (And most people don’t catch it that early).

Doesn’t have that “Fat is a sin” vibe Americans love, though. We do love to fat shame, don’t we?Report

Morat20 in reply to Dave says:

I’m not going to say diet isn’t a problem (in fact I heartily cheered the recent basic ditching of trans fats, which if nothing else was killing people from heart disease. We all go sooner or later, and heart attacks are gonna take a lot of us, but you don’t have to handicap yourself).

However, the more I read about weight loss, body weight, and the science behind it — it’s depressing. Our bodies have evolved to pack on pounds whenever possible, and to resist losing it. (Which makes sense if you don’t assume you’ll have a surplus of foods). Agriculture shot us in the foot on that one. Then you add in replacing “spending all your time finding food” with jobs that become increasingly sedentary…

I mean you don’t even have to get into culture specific issues to see that writing on the wall.

That doesn’t even get into the rat’s nest of hunger issues (your body is not shy about pushing ALL THE BUTTONS for food, because food = life. Eating, and eating plenty, is something your body wants on a bone-deep survival level) and how they’re tangled up in fat storage. (I was reading a recent paper that indicated that the mechanisms for signaling cravings and hunger were at least related to the ones that ditch fat cells, which makes sense).

And then there’s the fact that the body hates to get rid of a fat cell (empty it, sure. But ditch it? Not if it can help it). And then the research indicating “fat or thin” might be settled sometime in adolescence and that if you’re on the wrong track trying to switch is a lifelong battle.

And then you have fad diets (kill your health!), people hawking miracle cures, and shows like the Biggest Loser (if you make weight loss your job, yes you can lose a lot of weight. But you can’t ever retire, and you really can’t hold down another full time job. Also — it’s not even healthy weight loss, the levels they’re showing on that stupid show).

I’ve been seeing doctors talk more about surgery for bigger weight loss, about how that seems to be about the only thing that works and stays working. And even then, I’ve seen recent research that indicates the composition of your gut bacteria may play a role in how well that works.

Your body craves excess energy and loves to hoard fat, because we evolved to never know when our next meal was coming from. Plentiful autumn was always followed by sparse winters.Report